Psychological "Growth" through War and Disease: Sometimes It's Just a Cruel Delusion

A week ago, The New York Times magazine ran an article on what psychologists call “posttraumatic growth.” An experience that can purportedly occur subsequent to severe life trauma, it might be best titled “The Oprah Moment” for non-clinicians. It entails an arduous life experience—combat, cancer—that, once confronted, is said to engender psychological transformation that affords a more mature or positive perspective on things.

The article was a good piece, focusing on soldiers whose lives had been transformed by confronting adversity and it detailed the U.S. Army’s efforts to foster resilience and growth. Well-reported, it included the requisite caveats in the form of quotes by experts in the field who questioned whether enough evidence exists, beyond the talk shows, to characterize it as worthy of an entry in the DSM.

The history of posttraumatic growth, though, comes replete with a few blemishes that the Times missed. It turns out that people who contend they have begun to take time to smell the roses may actually be descending into a psychological abyss with sometimes bizarre and potentially tragic manifestations.

A paper that appeared in Applied Psychology in 2007 reviewed the results of studies conducted in New York following the Sept. 11 attack and in Israel during the Al Asqa Intifada and found that those who reported growth experiences were actually more liable to suffer psychological distress.

“We've probably got 20,000 people that we've studied on posttraumatic growth, mainly in the Middle East in Israel and Palestine,” said Stevan Hobfoll of Rush University Medical Center in an interview I conducted with him in November of 2010 for a feature I was writing at the time on psychological resilience, a conversation that ultimately ended up unused on my hard disk because resilience, I learned, may even be construed as the opposite of posttraumatic growth. (It would have made a nice sidebar for the resilience story. But, as often happens, no space...until now.)

Hobfoll and colleagues found that most of those in their studies who said they were engaged in a period of personal growth after witnessing the violence of the Intifada were deluding themselves. “They do report growth, they do report that they think they’re doing better,” Hobfoll said. “And then when we checked them on their depression and PTSD, they were actually doing worse.”

Even more disturbing was how “growth” had apparently reshaped their attitudes. “We also have a very uncomfortable finding that those people who report more traumatic growth are more vicious in how they want to kill the enemy and more rejecting of others and more authoritarian.” (“rigid, right-wing, support of violence and ethnocentrism,” as the researchers characterized their findings in one study of Israel and the territories.)

The Oprah mantra of strength through hardship is commonplace following a traumatic event but only materializes if the victim actually initiates some meaningful action to effect change, the investigators found. Simply saying “my life has changed forever” doesn’t cut it.

Hobfoll illustrated that point from his own experience by telling me about a friend who had provided assurances that he had “seen the light” after a heart attack that led to quintuple bypass surgery. “Another friend of mine and I take off work to go visit him when he gets out of the hospital and he’s not there when we get there, he’s late. And he comes in with the two cell phones going, one in each ear. His adult daughter is leaving in a huff because she's been there three days to see her almost-dying father and he hasn’t given her a minute. So he gives us the one-finger sign to say he’ll just be a minute and 20 minutes later he gets back to us and says: ‘I’m a changed man.’”

Growth is possible after potentially traumatic experiences, Hobfoll said, if the perception of it is coupled with specifc actions. Michael J. Fox as Parkinson’s spokesman and philanthropist has demonstrated as much. Victor Frankl, the psychiatrist who survived Auschwitz and helped pioneer the concept of psychological growth after hardship, wrote of “right action and right conduct” that, in the camps, translated into mutual aid that one prisoner would lend another at peril to himself.

Another way the “What doesn’t kill you…” meme can turn toxic stems from the unreasonable expectations it puts on the patient. “When people have undergone trauma, just getting to the next day may be enough,” Hobfoll said. “If clinicians and even the media start setting up that you have to grow from that experience, that really can be a burden and that can be an overwhelming burden, when you start feeling guilty that I'm just making it to work and continuing to be a parent to my kids and coaching the kids' soccer team and they're telling me that's not enough and that I have to have grown and all I really want to do is get through this. ”

Oprah narratives are probably best discarded at the door of the trauma specialist’s office.

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